Martin Kernberg MD Inc

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

License

62629 Issued in CA

Legal business name

MARTIN KERNBERG MD INC

Doing business as

Jefferson Pain Clinic

Practice address

1225 Marshall St
Ste 18
Crescent City, CA 95531-2281

Phone

(707) 464-1989

Fax

(707) 464-9593

NPI assigned

Sep 16, 2015

Last updated

Sep 16, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Martin Kernberg, MD

Title

Owner

Phone

(707) 464-1989

Specialties & licenses 2

Addresses

Other names 1

• Jefferson Pain Clinic Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Christine Ann Phelps, PA

  • Physician Assistant
  • Lorain, OH
  • NPI 1447333570
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1442361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442361600000",
    "number": "1780053033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1327 WALLER ST",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941172920",
            "telephone_number": "707-464-1989",
            "fax_number": "707-464-9593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 MARSHALL ST",
            "address_2": "STE 18",
            "city": "CRESCENT CITY",
            "state": "CA",
            "postal_code": "955312281",
            "telephone_number": "707-464-1989",
            "fax_number": "707-464-9593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARTIN KERNBERG MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-16",
        "last_updated": "2015-09-16",
        "status": "A",
        "authorized_official_last_name": "KERNBERG",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "707-464-1989",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "62629",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "CA",
            "license": "62629",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jefferson Pain Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lorama B Maloen, PH.D.
• David Marc Mandel, PH.D.
• Jody L Mangum, LAC
• Ashley Jane Maready, ASW
• Tiffany Gayle Martell, MSN, RN
• Keegan Martin, DPT
• Rhonda Dee Martinho, LVN
• Joshua Thomas Matson, PA
• Aaron Matthess
• Frederick Mayer, DPM

• Interventional Pain Medicine Physician in Crescent City, CA
• Providers in Crescent City, CA by specialty
• Interventional Pain Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.